🌍 Circadian Timing of Radiotherapy and Survival Outcomes
📌 Background & Rationale
Radiotherapy has "optimized" the "where" and "how much" of dose delivery, yet the "when"—the optimal time of day—remains a largely unexploited variable in precision medicine. Driven by circadian rhythms, the efficacy of ionizing radiation fluctuates based on the timing of DNA repair mechanisms and cell cycle phases. Theoretically, targeting specific circadian windows could improve outcomes, yet clinical data remain contradictory and scarce.
🔬 Study Design & The "Natural Experiment"
Unlike typical radiotherapy centers that operate only during daylight hours, our institution’s resource-constrained 22-hour operational model (07:00 to 05:00 the following day) provided an unprecedented 'natural experiment' opportunity. This allowed us to capture data from the rarely studied nocturnal window (00:00–06:00), filling a critical knowledge gap in chronobiology.
By utilizing a massive dataset derived directly from major Oncology Information Systems (ARIA and MOSAIQ), this study analyzed objective treatment timestamps from 86,433 patients treated between 2010 and 2025, encompassing 13 major cancer types such as nasopharyngeal carcinoma (NPC), lung cancer, and esophageal cancer. This approach effectively eliminates recall bias and provides the most comprehensive evaluation to date.
💡 Key Findings
Our analysis reveals significant heterogeneity in the survival impact of radiotherapy timing across tumor types:
🌙 Night treatment (00:00–06:00) significantly improved survival in nasopharyngeal (HR 0.65) and esophageal (HR 0.86) cancers.
☀️ Conversely, it increased mortality risk in lung cancer (HR 1.24) .
📊 Supplementary Data Navigation
[Table 1] Baseline Characteristics of the cohort.
[Table 2] Interaction Effects between tumor type and circadian timing.
[Figure 1B-C] RT Time Distribution: Polar plots at patient and fraction levels.
[Figure 2] Forest Plots: Main multivariable Cox regression visualization.
[Figure 3] Non-linear Trends (RCS): Restricted Cubic Splines modeling.
[eTable 1-6] Baseline Characteristics for six major tumor types.
[eTable 7-8] Seasonality Analysis: Assessing the impact of treatment season.
[eTable 9] Interaction Effects: Tumor type × Circadian timing interactions.
[eTable 10-15] Comprehensive Cox Data: Detailed numerical results for Figure 2.
[eTable 16-21] PSM Validation: Propensity Score Matching results.
[eTable 22-24] Core Tumor Sensitivity: Robustness checks and E-values.
[eFigure 1] Timing Deviation Distribution.
[eFigure 2-3] KM Survival Curves: Kaplan-Meier estimates across groups.
[eFigure 4-6] PSM Validation: Propensity Score Matching results.
[eFigure 7-9] Subgroup Analysis: Consistency across age, sex, and stage.
[eFigure 10] Sensitivity analysis for 10 years follow-up.
[eFigure 11-12] Timing Deviation: Sensitivity analysis excluding Δt > 2h.
📋 Please select a cohort to view baseline characteristics::
All Sites (Overall Population)
Nasopharyngeal Carcinoma
Lung Cancer
Cervix Cancer
Breast Cancer
Esophageal Cancer
Colorectal Cancer
Prostate Cancer
Gastric Cancer
Lymphoma
Liver Cancer
Other Head and Neck Cancer
Pancreas Cancer
Soft Tissue Sarcoma
Baseline Characteristics - Overall Population
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 86433 24193 28275 23275 10690
Cancer Type 0.000
Nasopharyngeal Carcinoma 5811 (6.7%) 1151 (4.8%) 1372 (4.9%) 1685 (7.2%) 1603 (15.0%)
Lung Cancer 6733 (7.8%) 1869 (7.7%) 2345 (8.3%) 1750 (7.5%) 769 (7.2%)
Cervix Cancer 6404 (7.4%) 1794 (7.4%) 2113 (7.5%) 2107 (9.1%) 390 (3.6%)
Breast Cancer 33650 (38.9%) 10199 (42.2%) 12110 (42.8%) 8770 (37.7%) 2571 (24.1%)
Esophageal Cancer 6323 (7.3%) 1499 (6.2%) 1744 (6.2%) 1660 (7.1%) 1420 (13.3%)
Colorectal Cancer 9184 (10.6%) 2426 (10.0%) 2670 (9.4%) 2442 (10.5%) 1646 (15.4%)
Prostate Cancer 1541 (1.8%) 576 (2.4%) 490 (1.7%) 264 (1.1%) 211 (2.0%)
Gastric Cancer 1919 (2.2%) 563 (2.3%) 617 (2.2%) 545 (2.3%) 194 (1.8%)
Lymphoma 2728 (3.2%) 630 (2.6%) 705 (2.5%) 684 (2.9%) 709 (6.6%)
Liver Cancer 834 (1.0%) 249 (1.0%) 241 (0.9%) 242 (1.0%) 102 (1.0%)
Other Head and Neck Cancer 1823 (2.1%) 465 (1.9%) 583 (2.1%) 520 (2.2%) 255 (2.4%)
Pancreas Cancer 1596 (1.8%) 507 (2.1%) 613 (2.2%) 403 (1.7%) 73 (0.7%)
Soft Tissue Sarcoma 1428 (1.7%) 377 (1.6%) 542 (1.9%) 401 (1.7%) 108 (1.0%)
Other 6459 (7.5%) 1888 (7.8%) 2130 (7.5%) 1802 (7.7%) 639 (6.0%)
Tumor Stage 0.000
0 375 (0.4%) 115 (0.5%) 138 (0.5%) 84 (0.4%) 38 (0.4%)
I 9324 (10.8%) 2869 (11.9%) 3235 (11.4%) 2260 (9.7%) 960 (9.0%)
II 9894 (11.4%) 2756 (11.4%) 3123 (11.0%) 2606 (11.2%) 1409 (13.2%)
III 8214 (9.5%) 1850 (7.6%) 2234 (7.9%) 2248 (9.7%) 1882 (17.6%)
IV 21918 (25.4%) 5718 (23.6%) 7002 (24.8%) 5643 (24.2%) 3555 (33.3%)
Recurrence 4168 (4.8%) 1193 (4.9%) 1331 (4.7%) 1066 (4.6%) 578 (5.4%)
Unknown 32540 (37.6%) 9692 (40.1%) 11212 (39.7%) 9368 (40.2%) 2268 (21.2%)
Age (years) 54.0 [45.0, 62.0] 55.0 [45.0, 63.0] 54.0 [45.0, 63.0] 52.0 [44.0, 61.0] 54.0 [45.0, 62.0] 0.000
Age Group 0.000
<=40 14191 (16.4%) 3653 (15.1%) 4591 (16.2%) 4182 (18.0%) 1765 (16.5%)
41-60 46256 (53.5%) 12604 (52.1%) 15086 (53.4%) 12842 (55.2%) 5724 (53.5%)
61-80 25375 (29.4%) 7699 (31.8%) 8387 (29.7%) 6130 (26.3%) 3159 (29.6%)
81+ 611 (0.7%) 237 (1.0%) 211 (0.7%) 121 (0.5%) 42 (0.4%)
Sex 0.000
Female 55081 (63.7%) 15924 (65.8%) 18972 (67.1%) 14959 (64.3%) 5226 (48.9%)
Male 31352 (36.3%) 8269 (34.2%) 9303 (32.9%) 8316 (35.7%) 5464 (51.1%)
Season (RT Start) 0.003
Spring 21542 (24.9%) 6016 (24.9%) 7123 (25.2%) 5758 (24.7%) 2645 (24.7%)
Summer 22280 (25.8%) 6151 (25.4%) 7176 (25.4%) 6075 (26.1%) 2878 (26.9%)
Autumn 22309 (25.8%) 6250 (25.8%) 7219 (25.5%) 6035 (25.9%) 2805 (26.2%)
Winter 20302 (23.5%) 5776 (23.9%) 6757 (23.9%) 5407 (23.2%) 2362 (22.1%)
Start-to-Approve Days 0.000
0-7 32062 (37.1%) 8688 (35.9%) 9719 (34.4%) 8853 (38.0%) 4802 (44.9%)
7-14 21460 (24.8%) 5680 (23.5%) 6935 (24.5%) 6038 (25.9%) 2807 (26.3%)
14-21 14436 (16.7%) 4118 (17.0%) 4910 (17.4%) 3900 (16.8%) 1508 (14.1%)
21-28 8760 (10.1%) 2545 (10.5%) 3146 (11.1%) 2283 (9.8%) 786 (7.4%)
>28 9715 (11.2%) 3162 (13.1%) 3565 (12.6%) 2201 (9.5%) 787 (7.4%)
Baseline Characteristics - Nasopharyngeal Carcinoma
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 5811 1151 1372 1685 1603
Tumor Stage 0.000
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 74 (1.3%) 15 (1.3%) 10 (0.7%) 20 (1.2%) 29 (1.8%)
II 391 (6.7%) 84 (7.3%) 78 (5.7%) 94 (5.6%) 135 (8.4%)
III 1578 (27.2%) 256 (22.2%) 357 (26.0%) 483 (28.7%) 482 (30.1%)
IV 3020 (52.0%) 573 (49.8%) 722 (52.6%) 852 (50.6%) 873 (54.5%)
Recurrence 237 (4.1%) 76 (6.6%) 64 (4.7%) 70 (4.2%) 27 (1.7%)
Unknown 511 (8.8%) 147 (12.8%) 141 (10.3%) 166 (9.9%) 57 (3.6%)
Age (years) 49.0 [41.0, 58.0] 51.0 [43.0, 59.5] 50.0 [42.0, 59.0] 49.0 [41.0, 56.0] 49.0 [40.0, 57.0] 0.000
Age Group 0.000
<=40 1346 (23.2%) 226 (19.6%) 300 (21.9%) 405 (24.0%) 415 (25.9%)
41-60 3432 (59.1%) 668 (58.0%) 809 (59.0%) 1013 (60.1%) 942 (58.8%)
61-80 1026 (17.7%) 252 (21.9%) 262 (19.1%) 266 (15.8%) 246 (15.3%)
81+ 7 (0.1%) 5 (0.4%) 1 (0.1%) 1 (0.1%) 0 (0.0%)
Sex 0.086
Female 1555 (26.8%) 297 (25.8%) 339 (24.7%) 460 (27.3%) 459 (28.6%)
Male 4256 (73.2%) 854 (74.2%) 1033 (75.3%) 1225 (72.7%) 1144 (71.4%)
Season (RT Start) 0.001
Spring 1393 (24.0%) 285 (24.8%) 339 (24.7%) 379 (22.5%) 390 (24.3%)
Summer 1529 (26.3%) 280 (24.3%) 314 (22.9%) 460 (27.3%) 475 (29.6%)
Autumn 1484 (25.5%) 303 (26.3%) 352 (25.7%) 433 (25.7%) 396 (24.7%)
Winter 1405 (24.2%) 283 (24.6%) 367 (26.7%) 413 (24.5%) 342 (21.3%)
Start-to-Approve Days 0.000
0-7 1773 (30.5%) 362 (31.5%) 354 (25.8%) 535 (31.8%) 522 (32.6%)
7-14 1410 (24.3%) 230 (20.0%) 285 (20.8%) 431 (25.6%) 464 (28.9%)
14-21 1256 (21.6%) 228 (19.8%) 291 (21.2%) 373 (22.1%) 364 (22.7%)
21-28 776 (13.4%) 159 (13.8%) 235 (17.1%) 214 (12.7%) 168 (10.5%)
>28 596 (10.3%) 172 (14.9%) 207 (15.1%) 132 (7.8%) 85 (5.3%)
Baseline Characteristics - Lung Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 6733 1869 2345 1750 769
Tumor Stage 0.000
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 194 (2.9%) 74 (4.0%) 69 (2.9%) 37 (2.1%) 14 (1.8%)
II 161 (2.4%) 49 (2.6%) 45 (1.9%) 45 (2.6%) 22 (2.9%)
III 914 (13.6%) 233 (12.5%) 246 (10.5%) 271 (15.5%) 164 (21.3%)
IV 3296 (49.0%) 903 (48.3%) 1258 (53.6%) 767 (43.8%) 368 (47.9%)
Recurrence 325 (4.8%) 87 (4.7%) 96 (4.1%) 90 (5.1%) 52 (6.8%)
Unknown 1843 (27.4%) 523 (28.0%) 631 (26.9%) 540 (30.9%) 149 (19.4%)
Age (years) 61.0 [54.0, 68.0] 62.0 [55.0, 68.0] 61.0 [54.0, 68.0] 60.0 [54.0, 67.0] 60.0 [53.0, 66.0] 0.000
Age Group 0.000
<=40 246 (3.7%) 53 (2.8%) 99 (4.2%) 71 (4.1%) 23 (3.0%)
41-60 3003 (44.6%) 763 (40.8%) 1035 (44.1%) 828 (47.3%) 377 (49.0%)
61-80 3419 (50.8%) 1026 (54.9%) 1187 (50.6%) 839 (47.9%) 367 (47.7%)
81+ 65 (1.0%) 27 (1.4%) 24 (1.0%) 12 (0.7%) 2 (0.3%)
Sex 0.041
Female 1857 (27.6%) 543 (29.1%) 666 (28.4%) 461 (26.3%) 187 (24.3%)
Male 4876 (72.4%) 1326 (70.9%) 1679 (71.6%) 1289 (73.7%) 582 (75.7%)
Season (RT Start) 0.000
Spring 1689 (25.1%) 473 (25.3%) 615 (26.2%) 404 (23.1%) 197 (25.6%)
Summer 1753 (26.0%) 442 (23.6%) 640 (27.3%) 440 (25.1%) 231 (30.0%)
Autumn 1727 (25.6%) 486 (26.0%) 605 (25.8%) 464 (26.5%) 172 (22.4%)
Winter 1564 (23.2%) 468 (25.0%) 485 (20.7%) 442 (25.3%) 169 (22.0%)
Start-to-Approve Days 0.000
0-7 3286 (48.8%) 895 (47.9%) 1122 (47.8%) 790 (45.1%) 479 (62.3%)
7-14 1735 (25.8%) 471 (25.2%) 592 (25.2%) 489 (27.9%) 183 (23.8%)
14-21 1008 (15.0%) 287 (15.4%) 352 (15.0%) 299 (17.1%) 70 (9.1%)
21-28 410 (6.1%) 115 (6.2%) 160 (6.8%) 108 (6.2%) 27 (3.5%)
>28 294 (4.4%) 101 (5.4%) 119 (5.1%) 64 (3.7%) 10 (1.3%)
Baseline Characteristics - Cervix Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 6404 1794 2113 2107 390
Tumor Stage 0.001
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 1299 (20.3%) 353 (19.7%) 431 (20.4%) 451 (21.4%) 64 (16.4%)
II 2456 (38.4%) 675 (37.6%) 803 (38.0%) 853 (40.5%) 125 (32.1%)
III 221 (3.5%) 61 (3.4%) 85 (4.0%) 57 (2.7%) 18 (4.6%)
IV 379 (5.9%) 103 (5.7%) 121 (5.7%) 124 (5.9%) 31 (7.9%)
Recurrence 274 (4.3%) 75 (4.2%) 101 (4.8%) 84 (4.0%) 14 (3.6%)
Unknown 1775 (27.7%) 527 (29.4%) 572 (27.1%) 538 (25.5%) 138 (35.4%)
Age (years) 51.0 [43.0, 57.0] 52.0 [44.0, 59.0] 51.0 [43.0, 58.0] 50.0 [42.0, 56.0] 49.0 [41.2, 57.0] 0.000
Age Group 0.001
<=40 1182 (18.5%) 292 (16.3%) 376 (17.8%) 422 (20.0%) 92 (23.6%)
41-60 4106 (64.1%) 1160 (64.7%) 1345 (63.7%) 1368 (64.9%) 233 (59.7%)
61-80 1111 (17.3%) 341 (19.0%) 390 (18.5%) 315 (15.0%) 65 (16.7%)
81+ 5 (0.1%) 1 (0.1%) 2 (0.1%) 2 (0.1%) 0 (0.0%)
Sex NA
Female 6404 (100.0%) 1794 (100.0%) 2113 (100.0%) 2107 (100.0%) 390 (100.0%)
Male 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Season (RT Start) 0.901
Spring 1560 (24.4%) 436 (24.3%) 533 (25.2%) 503 (23.9%) 88 (22.6%)
Summer 1780 (27.8%) 499 (27.8%) 590 (27.9%) 577 (27.4%) 114 (29.2%)
Autumn 1627 (25.4%) 464 (25.9%) 516 (24.4%) 541 (25.7%) 106 (27.2%)
Winter 1437 (22.4%) 395 (22.0%) 474 (22.4%) 486 (23.1%) 82 (21.0%)
Start-to-Approve Days 0.000
0-7 2387 (37.3%) 727 (40.5%) 726 (34.4%) 780 (37.0%) 154 (39.5%)
7-14 1701 (26.6%) 466 (26.0%) 547 (25.9%) 550 (26.1%) 138 (35.4%)
14-21 1255 (19.6%) 312 (17.4%) 436 (20.6%) 437 (20.7%) 70 (17.9%)
21-28 675 (10.5%) 165 (9.2%) 260 (12.3%) 225 (10.7%) 25 (6.4%)
>28 386 (6.0%) 124 (6.9%) 144 (6.8%) 115 (5.5%) 3 (0.8%)
Baseline Characteristics - Breast Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 33650 10199 12110 8770 2571
Tumor Stage 0.000
0 359 (1.1%) 110 (1.1%) 133 (1.1%) 82 (0.9%) 34 (1.3%)
I 6321 (18.8%) 2053 (20.1%) 2322 (19.2%) 1401 (16.0%) 545 (21.2%)
II 4649 (13.8%) 1406 (13.8%) 1591 (13.1%) 1071 (12.2%) 581 (22.6%)
III 1659 (4.9%) 444 (4.4%) 529 (4.4%) 421 (4.8%) 265 (10.3%)
IV 3936 (11.7%) 1129 (11.1%) 1448 (12.0%) 972 (11.1%) 387 (15.1%)
Recurrence 564 (1.7%) 161 (1.6%) 217 (1.8%) 123 (1.4%) 63 (2.5%)
Unknown 16162 (48.0%) 4896 (48.0%) 5870 (48.5%) 4700 (53.6%) 696 (27.1%)
Age (years) 49.0 [41.0, 57.0] 49.0 [42.0, 58.0] 49.0 [41.0, 58.0] 48.0 [41.0, 56.0] 47.0 [41.0, 54.0] 0.000
Age Group 0.000
<=40 7641 (22.7%) 2187 (21.4%) 2685 (22.2%) 2145 (24.5%) 624 (24.3%)
41-60 20324 (60.4%) 6145 (60.3%) 7199 (59.4%) 5324 (60.7%) 1656 (64.4%)
61-80 5643 (16.8%) 1852 (18.2%) 2208 (18.2%) 1293 (14.7%) 290 (11.3%)
81+ 42 (0.1%) 15 (0.1%) 18 (0.1%) 8 (0.1%) 1 (0.0%)
Sex 0.567
Female 33578 (99.8%) 10176 (99.8%) 12088 (99.8%) 8747 (99.7%) 2567 (99.8%)
Male 72 (0.2%) 23 (0.2%) 22 (0.2%) 23 (0.3%) 4 (0.2%)
Season (RT Start) 0.346
Spring 8312 (24.7%) 2544 (24.9%) 3002 (24.8%) 2145 (24.5%) 621 (24.2%)
Summer 8370 (24.9%) 2562 (25.1%) 2949 (24.4%) 2243 (25.6%) 616 (24.0%)
Autumn 8643 (25.7%) 2591 (25.4%) 3097 (25.6%) 2257 (25.7%) 698 (27.1%)
Winter 8325 (24.7%) 2502 (24.5%) 3062 (25.3%) 2125 (24.2%) 636 (24.7%)
Start-to-Approve Days 0.000
0-7 9602 (28.5%) 2674 (26.2%) 3335 (27.5%) 2759 (31.5%) 834 (32.4%)
7-14 7285 (21.6%) 2098 (20.6%) 2644 (21.8%) 1970 (22.5%) 573 (22.3%)
14-21 5729 (17.0%) 1816 (17.8%) 2097 (17.3%) 1415 (16.1%) 401 (15.6%)
21-28 4398 (13.1%) 1390 (13.6%) 1592 (13.1%) 1115 (12.7%) 301 (11.7%)
>28 6636 (19.7%) 2221 (21.8%) 2442 (20.2%) 1511 (17.2%) 462 (18.0%)
Baseline Characteristics - Esophageal Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 6323 1499 1744 1660 1420
Tumor Stage 0.000
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 208 (3.3%) 41 (2.7%) 58 (3.3%) 55 (3.3%) 54 (3.8%)
II 525 (8.3%) 101 (6.7%) 134 (7.7%) 116 (7.0%) 174 (12.3%)
III 763 (12.1%) 157 (10.5%) 190 (10.9%) 179 (10.8%) 237 (16.7%)
IV 2288 (36.2%) 468 (31.2%) 539 (30.9%) 595 (35.8%) 686 (48.3%)
Recurrence 433 (6.8%) 122 (8.1%) 127 (7.3%) 103 (6.2%) 81 (5.7%)
Unknown 2106 (33.3%) 610 (40.7%) 696 (39.9%) 612 (36.9%) 188 (13.2%)
Age (years) 64.0 [57.0, 70.0] 64.0 [58.0, 70.0] 64.0 [58.0, 70.0] 63.0 [56.0, 69.0] 64.0 [58.0, 69.0] 0.000
Age Group 0.000
<=40 36 (0.6%) 10 (0.7%) 9 (0.5%) 12 (0.7%) 5 (0.4%)
41-60 2300 (36.4%) 507 (33.8%) 642 (36.8%) 666 (40.1%) 485 (34.2%)
61-80 3806 (60.2%) 927 (61.8%) 1028 (58.9%) 939 (56.6%) 912 (64.2%)
81+ 181 (2.9%) 55 (3.7%) 65 (3.7%) 43 (2.6%) 18 (1.3%)
Sex 0.111
Female 1071 (16.9%) 236 (15.7%) 301 (17.3%) 267 (16.1%) 267 (18.8%)
Male 5252 (83.1%) 1263 (84.3%) 1443 (82.7%) 1393 (83.9%) 1153 (81.2%)
Season (RT Start) 0.425
Spring 1672 (26.4%) 389 (26.0%) 458 (26.3%) 445 (26.8%) 380 (26.8%)
Summer 1628 (25.7%) 366 (24.4%) 447 (25.6%) 422 (25.4%) 393 (27.7%)
Autumn 1651 (26.1%) 386 (25.8%) 468 (26.8%) 438 (26.4%) 359 (25.3%)
Winter 1372 (21.7%) 358 (23.9%) 371 (21.3%) 355 (21.4%) 288 (20.3%)
Start-to-Approve Days 0.000
0-7 3231 (51.1%) 720 (48.0%) 773 (44.3%) 788 (47.5%) 950 (66.9%)
7-14 1677 (26.5%) 374 (24.9%) 495 (28.4%) 486 (29.3%) 322 (22.7%)
14-21 828 (13.1%) 210 (14.0%) 281 (16.1%) 236 (14.2%) 101 (7.1%)
21-28 347 (5.5%) 102 (6.8%) 120 (6.9%) 92 (5.5%) 33 (2.3%)
>28 240 (3.8%) 93 (6.2%) 75 (4.3%) 58 (3.5%) 14 (1.0%)
Baseline Characteristics - Colorectal Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 9184 2426 2670 2442 1646
Tumor Stage 0.000
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 286 (3.1%) 70 (2.9%) 90 (3.4%) 77 (3.2%) 49 (3.0%)
II 583 (6.3%) 156 (6.4%) 167 (6.3%) 141 (5.8%) 119 (7.2%)
III 2345 (25.5%) 509 (21.0%) 594 (22.2%) 629 (25.8%) 613 (37.2%)
IV 2856 (31.1%) 856 (35.3%) 832 (31.2%) 721 (29.5%) 447 (27.2%)
Recurrence 733 (8.0%) 191 (7.9%) 230 (8.6%) 165 (6.8%) 147 (8.9%)
Unknown 2381 (25.9%) 644 (26.5%) 757 (28.4%) 709 (29.0%) 271 (16.5%)
Age (years) 58.0 [50.0, 65.0] 59.0 [51.0, 67.0] 58.0 [51.0, 65.8] 57.0 [49.0, 64.0] 56.0 [48.0, 63.0] 0.000
Age Group 0.000
<=40 825 (9.0%) 201 (8.3%) 227 (8.5%) 225 (9.2%) 172 (10.4%)
41-60 4672 (50.9%) 1140 (47.0%) 1328 (49.7%) 1281 (52.5%) 923 (56.1%)
61-80 3584 (39.0%) 1041 (42.9%) 1083 (40.6%) 916 (37.5%) 544 (33.0%)
81+ 103 (1.1%) 44 (1.8%) 32 (1.2%) 20 (0.8%) 7 (0.4%)
Sex 0.002
Female 3319 (36.1%) 830 (34.2%) 1023 (38.3%) 910 (37.3%) 556 (33.8%)
Male 5865 (63.9%) 1596 (65.8%) 1647 (61.7%) 1532 (62.7%) 1090 (66.2%)
Season (RT Start) 0.591
Spring 2432 (26.5%) 630 (26.0%) 699 (26.2%) 670 (27.4%) 433 (26.3%)
Summer 2474 (26.9%) 657 (27.1%) 736 (27.6%) 646 (26.5%) 435 (26.4%)
Autumn 2327 (25.3%) 627 (25.8%) 639 (23.9%) 626 (25.6%) 435 (26.4%)
Winter 1951 (21.2%) 512 (21.1%) 596 (22.3%) 500 (20.5%) 343 (20.8%)
Start-to-Approve Days 0.000
0-7 4146 (45.1%) 1128 (46.5%) 1123 (42.1%) 1027 (42.1%) 868 (52.7%)
7-14 2738 (29.8%) 658 (27.1%) 784 (29.4%) 770 (31.5%) 526 (32.0%)
14-21 1347 (14.7%) 372 (15.3%) 414 (15.5%) 396 (16.2%) 165 (10.0%)
21-28 598 (6.5%) 159 (6.6%) 214 (8.0%) 172 (7.0%) 53 (3.2%)
>28 355 (3.9%) 109 (4.5%) 135 (5.1%) 77 (3.2%) 34 (2.1%)
Baseline Characteristics - Prostate Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 1541 576 490 264 211
Tumor Stage 0.000
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 99 (6.4%) 39 (6.8%) 28 (5.7%) 18 (6.8%) 14 (6.6%)
II 67 (4.3%) 25 (4.3%) 16 (3.3%) 5 (1.9%) 21 (10.0%)
III 29 (1.9%) 10 (1.7%) 7 (1.4%) 6 (2.3%) 6 (2.8%)
IV 568 (36.9%) 196 (34.0%) 176 (35.9%) 100 (37.9%) 96 (45.5%)
Recurrence 190 (12.3%) 73 (12.7%) 48 (9.8%) 30 (11.4%) 39 (18.5%)
Unknown 588 (38.2%) 233 (40.5%) 215 (43.9%) 105 (39.8%) 35 (16.6%)
Age (years) 66.0 [61.0, 71.0] 67.0 [62.0, 72.0] 66.0 [61.0, 71.0] 64.5 [60.0, 71.0] 63.0 [58.0, 70.0] 0.000
Age Group 0.000
<=40 6 (0.4%) 1 (0.2%) 1 (0.2%) 2 (0.8%) 2 (0.9%)
41-60 360 (23.4%) 105 (18.2%) 109 (22.2%) 74 (28.0%) 72 (34.1%)
61-80 1133 (73.5%) 449 (78.0%) 370 (75.5%) 181 (68.6%) 133 (63.0%)
81+ 42 (2.7%) 21 (3.6%) 10 (2.0%) 7 (2.7%) 4 (1.9%)
Sex 0.543
Female 1 (0.1%) 0 (0.0%) 1 (0.2%) 0 (0.0%) 0 (0.0%)
Male 1540 (99.9%) 576 (100.0%) 489 (99.8%) 264 (100.0%) 211 (100.0%)
Season (RT Start) 0.046
Spring 386 (25.0%) 152 (26.4%) 111 (22.7%) 69 (26.1%) 54 (25.6%)
Summer 418 (27.1%) 156 (27.1%) 130 (26.5%) 84 (31.8%) 48 (22.7%)
Autumn 394 (25.6%) 142 (24.7%) 127 (25.9%) 73 (27.7%) 52 (24.6%)
Winter 343 (22.3%) 126 (21.9%) 122 (24.9%) 38 (14.4%) 57 (27.0%)
Start-to-Approve Days 0.000
0-7 485 (31.5%) 169 (29.3%) 154 (31.4%) 108 (40.9%) 54 (25.6%)
7-14 438 (28.4%) 186 (32.3%) 133 (27.1%) 75 (28.4%) 44 (20.9%)
14-21 302 (19.6%) 120 (20.8%) 97 (19.8%) 43 (16.3%) 42 (19.9%)
21-28 162 (10.5%) 53 (9.2%) 59 (12.0%) 19 (7.2%) 31 (14.7%)
>28 154 (10.0%) 48 (8.3%) 47 (9.6%) 19 (7.2%) 40 (19.0%)
Baseline Characteristics - Gastric Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 1919 563 617 545 194
Tumor Stage 0.513
0 1 (0.1%) 0 (0.0%) 1 (0.2%) 0 (0.0%) 0 (0.0%)
I 27 (1.4%) 12 (2.1%) 5 (0.8%) 6 (1.1%) 4 (2.1%)
II 42 (2.2%) 10 (1.8%) 13 (2.1%) 11 (2.0%) 8 (4.1%)
III 111 (5.8%) 33 (5.9%) 32 (5.2%) 34 (6.2%) 12 (6.2%)
IV 992 (51.7%) 281 (49.9%) 332 (53.8%) 277 (50.8%) 102 (52.6%)
Recurrence 120 (6.3%) 35 (6.2%) 31 (5.0%) 39 (7.2%) 15 (7.7%)
Unknown 626 (32.6%) 192 (34.1%) 203 (32.9%) 178 (32.7%) 53 (27.3%)
Age (years) 59.0 [51.0, 66.0] 60.0 [53.0, 67.0] 58.0 [50.0, 66.0] 58.0 [50.0, 65.0] 56.0 [49.2, 64.0] 0.001
Age Group 0.029
<=40 178 (9.3%) 45 (8.0%) 60 (9.7%) 59 (10.8%) 14 (7.2%)
41-60 906 (47.2%) 249 (44.2%) 290 (47.0%) 254 (46.6%) 113 (58.2%)
61-80 820 (42.7%) 267 (47.4%) 261 (42.3%) 226 (41.5%) 66 (34.0%)
81+ 15 (0.8%) 2 (0.4%) 6 (1.0%) 6 (1.1%) 1 (0.5%)
Sex 0.930
Female 521 (27.1%) 147 (26.1%) 171 (27.7%) 150 (27.5%) 53 (27.3%)
Male 1398 (72.9%) 416 (73.9%) 446 (72.3%) 395 (72.5%) 141 (72.7%)
Season (RT Start) 0.135
Spring 494 (25.7%) 141 (25.0%) 172 (27.9%) 136 (25.0%) 45 (23.2%)
Summer 514 (26.8%) 140 (24.9%) 154 (25.0%) 151 (27.7%) 69 (35.6%)
Autumn 485 (25.3%) 152 (27.0%) 157 (25.4%) 140 (25.7%) 36 (18.6%)
Winter 426 (22.2%) 130 (23.1%) 134 (21.7%) 118 (21.7%) 44 (22.7%)
Start-to-Approve Days 0.000
0-7 772 (40.2%) 220 (39.1%) 245 (39.7%) 207 (38.0%) 100 (51.5%)
7-14 552 (28.8%) 154 (27.4%) 151 (24.5%) 191 (35.0%) 56 (28.9%)
14-21 300 (15.6%) 87 (15.5%) 114 (18.5%) 80 (14.7%) 19 (9.8%)
21-28 157 (8.2%) 50 (8.9%) 55 (8.9%) 42 (7.7%) 10 (5.2%)
>28 138 (7.2%) 52 (9.2%) 52 (8.4%) 25 (4.6%) 9 (4.6%)
Baseline Characteristics - Lymphoma
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 2728 630 705 684 709
Tumor Stage 0.005
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 381 (14.0%) 73 (11.6%) 87 (12.3%) 89 (13.0%) 132 (18.6%)
II 592 (21.7%) 144 (22.9%) 143 (20.3%) 146 (21.3%) 159 (22.4%)
III 127 (4.7%) 30 (4.8%) 32 (4.5%) 38 (5.6%) 27 (3.8%)
IV 354 (13.0%) 80 (12.7%) 115 (16.3%) 77 (11.3%) 82 (11.6%)
Recurrence 103 (3.8%) 30 (4.8%) 26 (3.7%) 21 (3.1%) 26 (3.7%)
Unknown 1171 (42.9%) 273 (43.3%) 302 (42.8%) 313 (45.8%) 283 (39.9%)
Age (years) 50.0 [35.0, 61.0] 53.5 [38.0, 63.0] 51.0 [35.0, 62.0] 46.5 [33.0, 59.0] 50.0 [36.0, 60.0] 0.000
Age Group 0.000
<=40 890 (32.6%) 182 (28.9%) 231 (32.8%) 253 (37.0%) 224 (31.6%)
41-60 1123 (41.2%) 241 (38.3%) 272 (38.6%) 299 (43.7%) 311 (43.9%)
61-80 688 (25.2%) 195 (31.0%) 195 (27.7%) 126 (18.4%) 172 (24.3%)
81+ 27 (1.0%) 12 (1.9%) 7 (1.0%) 6 (0.9%) 2 (0.3%)
Sex 0.918
Female 1157 (42.4%) 274 (43.5%) 295 (41.8%) 286 (41.8%) 302 (42.6%)
Male 1571 (57.6%) 356 (56.5%) 410 (58.2%) 398 (58.2%) 407 (57.4%)
Season (RT Start) 0.095
Spring 672 (24.6%) 146 (23.2%) 193 (27.4%) 180 (26.3%) 153 (21.6%)
Summer 705 (25.8%) 177 (28.1%) 180 (25.5%) 164 (24.0%) 184 (26.0%)
Autumn 711 (26.1%) 157 (24.9%) 177 (25.1%) 167 (24.4%) 210 (29.6%)
Winter 640 (23.5%) 150 (23.8%) 155 (22.0%) 173 (25.3%) 162 (22.8%)
Start-to-Approve Days 0.000
0-7 1074 (39.4%) 249 (39.5%) 259 (36.7%) 326 (47.7%) 240 (33.9%)
7-14 655 (24.0%) 139 (22.1%) 169 (24.0%) 170 (24.9%) 177 (25.0%)
14-21 466 (17.1%) 122 (19.4%) 132 (18.7%) 91 (13.3%) 121 (17.1%)
21-28 286 (10.5%) 70 (11.1%) 78 (11.1%) 54 (7.9%) 84 (11.8%)
>28 247 (9.1%) 50 (7.9%) 67 (9.5%) 43 (6.3%) 87 (12.3%)
Baseline Characteristics - Liver Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 834 249 241 242 102
Tumor Stage 0.764
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 3 (0.4%) 1 (0.4%) 0 (0.0%) 2 (0.8%) 0 (0.0%)
II 13 (1.6%) 5 (2.0%) 3 (1.2%) 4 (1.7%) 1 (1.0%)
III 17 (2.0%) 5 (2.0%) 5 (2.1%) 5 (2.1%) 2 (2.0%)
IV 400 (48.0%) 106 (42.6%) 123 (51.0%) 117 (48.3%) 54 (52.9%)
Recurrence 91 (10.9%) 36 (14.5%) 24 (10.0%) 21 (8.7%) 10 (9.8%)
Unknown 310 (37.2%) 96 (38.6%) 86 (35.7%) 93 (38.4%) 35 (34.3%)
Age (years) 56.0 [48.0, 64.0] 58.0 [51.0, 65.0] 55.0 [47.0, 62.0] 57.0 [48.2, 65.0] 53.5 [43.2, 61.0] 0.002
Age Group 0.039
<=40 99 (11.9%) 24 (9.6%) 30 (12.4%) 25 (10.3%) 20 (19.6%)
41-60 437 (52.4%) 120 (48.2%) 138 (57.3%) 124 (51.2%) 55 (53.9%)
61-80 291 (34.9%) 102 (41.0%) 71 (29.5%) 92 (38.0%) 26 (25.5%)
81+ 7 (0.8%) 3 (1.2%) 2 (0.8%) 1 (0.4%) 1 (1.0%)
Sex 0.993
Female 191 (22.9%) 58 (23.3%) 56 (23.2%) 54 (22.3%) 23 (22.5%)
Male 643 (77.1%) 191 (76.7%) 185 (76.8%) 188 (77.7%) 79 (77.5%)
Season (RT Start) 0.117
Spring 203 (24.3%) 72 (28.9%) 46 (19.1%) 64 (26.4%) 21 (20.6%)
Summer 208 (24.9%) 61 (24.5%) 68 (28.2%) 62 (25.6%) 17 (16.7%)
Autumn 241 (28.9%) 66 (26.5%) 72 (29.9%) 67 (27.7%) 36 (35.3%)
Winter 182 (21.8%) 50 (20.1%) 55 (22.8%) 49 (20.2%) 28 (27.5%)
Start-to-Approve Days 0.005
0-7 453 (54.3%) 128 (51.4%) 129 (53.5%) 121 (50.0%) 75 (73.5%)
7-14 204 (24.5%) 63 (25.3%) 62 (25.7%) 58 (24.0%) 21 (20.6%)
14-21 108 (12.9%) 33 (13.3%) 30 (12.4%) 41 (16.9%) 4 (3.9%)
21-28 40 (4.8%) 11 (4.4%) 13 (5.4%) 14 (5.8%) 2 (2.0%)
>28 29 (3.5%) 14 (5.6%) 7 (2.9%) 8 (3.3%) 0 (0.0%)
Baseline Characteristics - Other Head and Neck Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 1823 465 583 520 255
Tumor Stage 0.000
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 95 (5.2%) 29 (6.2%) 20 (3.4%) 21 (4.0%) 25 (9.8%)
II 101 (5.5%) 20 (4.3%) 28 (4.8%) 34 (6.5%) 19 (7.5%)
III 173 (9.5%) 33 (7.1%) 56 (9.6%) 51 (9.8%) 33 (12.9%)
IV 721 (39.6%) 174 (37.4%) 255 (43.7%) 181 (34.8%) 111 (43.5%)
Recurrence 89 (4.9%) 17 (3.7%) 26 (4.5%) 32 (6.2%) 14 (5.5%)
Unknown 644 (35.3%) 192 (41.3%) 198 (34.0%) 201 (38.7%) 53 (20.8%)
Age (years) 57.0 [48.5, 64.0] 58.0 [50.0, 66.0] 58.0 [50.0, 65.0] 56.0 [47.0, 63.0] 54.0 [46.0, 62.0] 0.000
Age Group 0.002
<=40 221 (12.1%) 44 (9.5%) 65 (11.1%) 73 (14.0%) 39 (15.3%)
41-60 926 (50.8%) 226 (48.6%) 286 (49.1%) 273 (52.5%) 141 (55.3%)
61-80 660 (36.2%) 190 (40.9%) 222 (38.1%) 173 (33.3%) 75 (29.4%)
81+ 16 (0.9%) 5 (1.1%) 10 (1.7%) 1 (0.2%) 0 (0.0%)
Sex 0.002
Female 478 (26.2%) 96 (20.6%) 159 (27.3%) 161 (31.0%) 62 (24.3%)
Male 1345 (73.8%) 369 (79.4%) 424 (72.7%) 359 (69.0%) 193 (75.7%)
Season (RT Start) 0.517
Spring 432 (23.7%) 119 (25.6%) 142 (24.4%) 116 (22.3%) 55 (21.6%)
Summer 488 (26.8%) 110 (23.7%) 153 (26.2%) 146 (28.1%) 79 (31.0%)
Autumn 473 (25.9%) 114 (24.5%) 153 (26.2%) 139 (26.7%) 67 (26.3%)
Winter 430 (23.6%) 122 (26.2%) 135 (23.2%) 119 (22.9%) 54 (21.2%)
Start-to-Approve Days 0.024
0-7 786 (43.1%) 198 (42.6%) 232 (39.8%) 243 (46.7%) 113 (44.3%)
7-14 498 (27.3%) 119 (25.6%) 157 (26.9%) 139 (26.7%) 83 (32.5%)
14-21 299 (16.4%) 73 (15.7%) 104 (17.8%) 82 (15.8%) 40 (15.7%)
21-28 136 (7.5%) 45 (9.7%) 46 (7.9%) 34 (6.5%) 11 (4.3%)
>28 104 (5.7%) 30 (6.5%) 44 (7.5%) 22 (4.2%) 8 (3.1%)
Baseline Characteristics - Pancreas Cancer
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 1596 507 613 403 73
Tumor Stage 0.533
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 34 (2.1%) 16 (3.2%) 11 (1.8%) 6 (1.5%) 1 (1.4%)
II 67 (4.2%) 20 (3.9%) 26 (4.2%) 17 (4.2%) 4 (5.5%)
III 48 (3.0%) 17 (3.4%) 16 (2.6%) 14 (3.5%) 1 (1.4%)
IV 557 (34.9%) 162 (32.0%) 222 (36.2%) 148 (36.7%) 25 (34.2%)
Recurrence 158 (9.9%) 43 (8.5%) 61 (10.0%) 42 (10.4%) 12 (16.4%)
Unknown 732 (45.9%) 249 (49.1%) 277 (45.2%) 176 (43.7%) 30 (41.1%)
Age (years) 60.0 [54.0, 67.0] 61.0 [54.0, 68.0] 60.0 [54.0, 67.0] 60.0 [53.0, 67.0] 60.0 [55.0, 65.0] 0.302
Age Group 0.070
<=40 47 (2.9%) 20 (3.9%) 9 (1.5%) 18 (4.5%) 0 (0.0%)
41-60 753 (47.2%) 222 (43.8%) 303 (49.4%) 191 (47.4%) 37 (50.7%)
61-80 780 (48.9%) 261 (51.5%) 293 (47.8%) 191 (47.4%) 35 (47.9%)
81+ 16 (1.0%) 4 (0.8%) 8 (1.3%) 3 (0.7%) 1 (1.4%)
Sex 0.254
Female 698 (43.7%) 215 (42.4%) 287 (46.8%) 167 (41.4%) 29 (39.7%)
Male 898 (56.3%) 292 (57.6%) 326 (53.2%) 236 (58.6%) 44 (60.3%)
Season (RT Start) 0.215
Spring 406 (25.4%) 117 (23.1%) 145 (23.7%) 121 (30.0%) 23 (31.5%)
Summer 399 (25.0%) 123 (24.3%) 159 (25.9%) 104 (25.8%) 13 (17.8%)
Autumn 440 (27.6%) 152 (30.0%) 170 (27.7%) 98 (24.3%) 20 (27.4%)
Winter 351 (22.0%) 115 (22.7%) 139 (22.7%) 80 (19.9%) 17 (23.3%)
Start-to-Approve Days 0.001
0-7 669 (41.9%) 207 (40.8%) 232 (37.8%) 184 (45.7%) 46 (63.0%)
7-14 496 (31.1%) 155 (30.6%) 190 (31.0%) 132 (32.8%) 19 (26.0%)
14-21 265 (16.6%) 89 (17.6%) 114 (18.6%) 55 (13.6%) 7 (9.6%)
21-28 112 (7.0%) 35 (6.9%) 51 (8.3%) 25 (6.2%) 1 (1.4%)
>28 54 (3.4%) 21 (4.1%) 26 (4.2%) 7 (1.7%) 0 (0.0%)
Baseline Characteristics - Soft Tissue Sarcoma
Characteristic Overall Morning (06:00-12:00) Afternoon (12:00-18:00) Evening (18:00-24:00) Night (00:00-06:00) P-value
N 1428 377 542 401 108
Tumor Stage 0.137
0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
I 62 (4.3%) 14 (3.7%) 26 (4.8%) 14 (3.5%) 8 (7.4%)
II 24 (1.7%) 7 (1.9%) 8 (1.5%) 4 (1.0%) 5 (4.6%)
III 12 (0.8%) 5 (1.3%) 3 (0.6%) 2 (0.5%) 2 (1.9%)
IV 331 (23.2%) 74 (19.6%) 130 (24.0%) 103 (25.7%) 24 (22.2%)
Recurrence 308 (21.6%) 83 (22.0%) 112 (20.7%) 95 (23.7%) 18 (16.7%)
Unknown 691 (48.4%) 194 (51.5%) 263 (48.5%) 183 (45.6%) 51 (47.2%)
Age (years) 47.0 [32.0, 59.0] 50.0 [33.0, 61.0] 48.0 [33.0, 60.0] 43.0 [29.0, 55.0] 49.0 [35.0, 61.0] 0.000
Age Group 0.028
<=40 547 (38.3%) 133 (35.3%) 199 (36.7%) 175 (43.6%) 40 (37.0%)
41-60 551 (38.6%) 140 (37.1%) 211 (38.9%) 160 (39.9%) 40 (37.0%)
61-80 316 (22.1%) 98 (26.0%) 127 (23.4%) 65 (16.2%) 26 (24.1%)
81+ 14 (1.0%) 6 (1.6%) 5 (0.9%) 1 (0.2%) 2 (1.9%)
Sex 0.806
Female 686 (48.0%) 185 (49.1%) 253 (46.7%) 198 (49.4%) 50 (46.3%)
Male 742 (52.0%) 192 (50.9%) 289 (53.3%) 203 (50.6%) 58 (53.7%)
Season (RT Start) 0.693
Spring 338 (23.7%) 85 (22.5%) 132 (24.4%) 95 (23.7%) 26 (24.1%)
Summer 358 (25.1%) 100 (26.5%) 129 (23.8%) 96 (23.9%) 33 (30.6%)
Autumn 391 (27.4%) 95 (25.2%) 147 (27.1%) 120 (29.9%) 29 (26.9%)
Winter 341 (23.9%) 97 (25.7%) 134 (24.7%) 90 (22.4%) 20 (18.5%)
Start-to-Approve Days 0.000
0-7 536 (37.5%) 163 (43.2%) 176 (32.5%) 151 (37.7%) 46 (42.6%)
7-14 352 (24.6%) 82 (21.8%) 131 (24.2%) 105 (26.2%) 34 (31.5%)
14-21 259 (18.1%) 56 (14.9%) 99 (18.3%) 88 (21.9%) 16 (14.8%)
21-28 154 (10.8%) 47 (12.5%) 70 (12.9%) 30 (7.5%) 7 (6.5%)
>28 127 (8.9%) 29 (7.7%) 66 (12.2%) 27 (6.7%) 5 (4.6%)
📊 Select deviation analysis chart to view:
⏱️ Fraction-level Timing Deviation
🔥 Daily vs. Median Time Heatmap
👤 Patient-level Median Absolute Deviation (MAD)